目的

探讨经脐横行小切口在单孔腹腔镜减重手术中的可行性、安全性和临床效果。

方法

回顾性分析2022年1月至2023年9月中国医学科学院整形外科医院减重与代谢外科收治的336例行经脐单孔腹腔镜减重手术的肥胖症患者临床资料，其中男87例，女249例；平均年龄为（37.0±6.5）岁，平均BMI为（39.3±6.3）kg/m²。通过分析患者脐照片对脐型进行分类，使用瘢痕评价量表和亲朋推荐意愿问卷来评估瘢痕状况和患者满意度。

结果

336例经脐单孔腹腔镜减重手术包括321例袖状胃切除术（SG）、6例Roux-en-Y胃旁路术（RYGB）、6例袖状胃切除联合单吻合口十二指肠转位术（SADI-S）、3例单吻合口胃旁路术（OAGB）和28例同期联合胆囊切除术。脐型分类结果为水平型47.3%、T型24.4%、椭圆型17.0%、垂直型4.9%、扭曲型6.5%。手术开孔时间为（5±3）min，关孔时间为（12±5） min，开关孔步骤总出血量为（4±2）mL。6例患者（1.8%）出现切口并发症，包括3例切口感染（0.9%，均为浅表感染），2例切口裂开（0.6%）和1例切口疝（0.3%）。术后平均住院时间为（3±1）d，79%患者在术后3 d内出院。术后第0、1、2和3日的切口疼痛VAS评分分别为2.6、1.5、1.2和0.6分。切口瘢痕评估量表调查结果示总平均分为63.5/70，针对该手术的亲朋推荐意愿平均分为8.5/9。

结论

经脐横行小切口方法应用于肥胖症患者的减重手术效果良好，符合脐解剖特点，安全可行，美容效果满意。

Objective

To investigate the feasibility，safety，and clinical outcomes of a transumbilical horizontal incision in single-incision laparoscopic surgery （SILS） for bariatric procedures.

Methods

Employing a retrospective and descriptive approach，this research analyzed clinical data from 336 patients treated for obesity by single-incision laparoscopic surgery at the Department of Bariatric and Metabolic Surgery in Plastic Surgery Hospital of Chinese Academy of Medical Sciences，between January 2022 and September 2023.The cohort included 87 males and 249 females，with an average age of（37.0±6.5） years and an average BMI of （39.3±6.3） kg/m².Patients' umbilical types were classified through a detailed analysis of photographs.The Scar assessment scales and Ultimate Question questionnaires were used to evaluate scar conditions and patient satisfaction.

Results

All 336 patients successfully underwent transumbilical SILS，including 321 sleeve gastrectomy （SG），6 Roux-en-Y gastric bypass （RYGB），6 single anastomosis duodeno-ileal bypass with sleeve gastrectomy （SADI-S），3 one anastomosis gastric bypass（OAGB），and 28 concomitant cholecystectomies.Umbilical types were classified as horizontal （47.3%），T-shaped （24.4%），oval （17.0%），vertical （4.8%），and distorted （6.5%）.The times for incision opening were 5±3 min and for closing 12±5 min，with total blood loss for these steps being （4±2） mL.Incision-related complications occurred in 6 patients （1.8%），including 3 cases of superficial infections （0.9%），2 of incision dehiscence （0.6%），and 1 of incisional hernia （0.3%）.The average postoperative hospital stay was （3±1）days，with 79% of patients discharged within 3 days postoperatively.The incision's Visual Analog Scale （VAS）scores on postoperative days 0，1，2，and 3 were 2.6，1.5，1.2，and 0.6，respectively.The average total score on the Scar Assessment Scale was 63.5/70，and the average score for the Ultimate Question questionnaires was 8.5/9.

Conclusions

The application of transumbilical horizontal incisions in bariatric surgery for obese patients is demonstrably effective，safe，and aesthetically pleasing，aligning well with the natural anatomy of the umbilicus.